Consumer Assistance Worker Credentialing Practice Exam

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• An entity that provides medical care and coordinates health services for Medicaid enrollees through a contract with the Maryland Department of Health.
• Which term refers to the document that outlines benefits, cost-sharing, and coverage options to compare plans?
• P02 Coverage Group applies to which population?
• A team of navigators located in every county in Maryland helping consumers determine if they qualify for lower costs for a health plan or for free health coverage through Medicaid is known as what?
• Transitional Medical Assistance (TMA) provides up to how long?
• MAGI is used to determine eligibility for which programs in Maryland Health Connection?
• Which term describes the annual limit that caps how much a plan will pay within a year?
• Which term describes ongoing self-evaluation and personal critique of one's biases when engaging with diverse populations?
• Under the Fee-for-Service model, how does the state pay providers for covered services?
• Which statement is true about Gold and Silver plans before the deductible is met?
• Bronze plans include up to three visits to primary care physicians before deductible; Value Plans cover core benefits with copays before deductible. Which statement is accurate?
• Which acronym stands for the health policy law that provides rights and protections to consumers?
• Which term describes the threshold used to calculate eligibility for subsidies and Medicaid, updated annually by HHS?
• Which role is described as full-service, guiding individuals through every step of the eligibility and enrollment process, including Medicaid eligibility and enrolling in a QHP?
• What is the term for the list of doctors, other health care providers, and hospitals a plan has contracted with to provide care?
• Which term describes a plan that meets minimum essential coverage requirements and is offered through the marketplace?
• During which period do consumers typically enroll or change coverage for the following year?
• Money earned by any person who can be claimed as a dependent on his/her parent's (or another person's) tax return.
• Which role is independent or affiliated with insurance agencies and has access to the Broker Portal on the Maryland Health Connection exchange?
• Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include oxygen equipment, wheelchairs, crutches, or blood testing strips for diabetics.
• Which term describes the informal review of an appeal prior to a formal hearing, conducted by MHBE representatives?
• Which term refers to services or treatments that are not covered by the insurance plan?
• What is the umbrella term for language access resources that include in-person assistance, TTY, Spanish applications, and certified bilingual staff?
• Which term refers to a group of plans that have similar value and shows the portion of total benefit costs paid by the plan?
• Which term is used to describe newborns whose mothers were enrolled in Medicaid at birth and who qualify for 13 months of P06 coverage regardless of income?
• Which role specializes in Medicaid enrollment and handles complex questions about eligibility, and is employed by the Maryland Department of Health and the Department of Human Services?
• Which term describes individuals who comprise a family unit and who either live together under the same roof or are claimed together on the same tax return?
• How many days do consumers have from the date of change to report?
• What is the purpose of the Summary of Benefits and Coverage (SBC)?
• Which statement is true about Value Plan features?
• Which is the state's online eligibility and enrollment site for ACA programs?
• As of Eff-04/01/22, how long is the extended postpartum period?
• Any person not a citizen of the United States who is living in the U.S. under legally recognized and lawfully recorded permanent residence as an immigrant.
• Modified Adjusted Gross Income (MAGI) is defined as an individual's adjusted gross income plus which of the following?
• What term describes the total amount an applicant may have to pay for health plan coverage, estimated before receiving coverage?
• If consumers choose to receive advance premium tax credits or plan to claim the premium tax credit, what must they do?
• After meeting the deductible, paying a percentage of the cost of a service is called what?
• Which role provides centralized assistance by phone about applications and enrollment and works directly for the Maryland Health Connection?
• Tier 1 usually includes which type of medications?
• When should a Medicaid beneficiary choose an MCO?
• Under the Social Media Policy, which action is allowed for CAWs?
• Which plan type usually requires a referral from your primary care doctor to see a specialist, and emphasizes care from network providers?
• Which law imposes liability on persons who defraud federal government programs, such as Medicaid?
• A limited benefit program for nonqualified, ineligible aliens who meet all eligibility requirements for full Medicaid coverage except citizenship or immigration status is known as what?
• Which statement is true about differences between QHPs and SADPs?
• Which term denotes an authorized insurance broker who assists consumers with Maryland Health Connection plan selection?
• A request for payment that an applicant or the applicant's health care provider submits to their health insurer after they receive items or services they think are covered is called a what?
• PARIS stands for which system?
• Which term describes a parent or other relative by blood, marriage, or adoption who lives with and cares for an unmarried child under 21 in the absence of parental support?
• Which term describes a health insurance plan that meets federal criteria and is offered through the health insurance marketplace to provide comprehensive coverage?
• Which statement about SSN collection in the Non-Financial Eligibility section is correct?
• What does 'minimum value' mean in health coverage terms?
• Which coverage group includes deemed newborns and under-one children with income up to 199% FPL?
• What is the term for the tax credit that reduces the monthly premium for health insurance purchases made through Maryland Health Connection?
• Which act imposes liability on those who knowingly make false or fraudulent claims for payment to a state or county government entity?
• Which statement about Young Adult Subsidy Recipients is true?
• The consumer assistance call center established in accordance with the requirement to operate a toll-free hotline under the Affordable Care Act is called what?
• What is the maximum amount a plan will pay for a covered health care service?
• Which Maryland Medicaid program provides rapid screening to determine eligibility for certain services based on presumptive criteria?
• What is the name of Maryland's system that serves as the state-based marketplace for insurance affordability programs?
• What term refers to a health problem that started before an individual's health insurance went into effect?
• Occurs when someone deceives an insurance company or consumer in an insurance transaction for financial gain.
• Which federal law prohibits offering or paying kickbacks to induce referrals for items or services reimbursable by federal health care programs?
• Which Maryland coverage group is associated with consumers whose income is less than 264% of the federal poverty level?
• What is the program that assesses whether an individual qualifies for health insurance offerings in the Maryland Health Benefit Exchange?
• Which item is NOT included in MAGI calculation?
• Which term describes the decision by MHBE that assesses whether an individual qualifies for health insurance offerings in the Maryland Health Benefit Exchange?
• What term describes a health care provider that has not contracted with the plan?
• Which term is the maximum predetermined amount that a health insurance plan will pay for a covered service?
• When was the ACA signed into legislation?
• Which term is used to describe the threshold used to determine eligibility for health programs and subsidies, updated annually by HHS?
• Which term best describes the cap on benefits paid within a year, which may be defined by a dollar amount or by number of visits?
• Which function best describes the Fulfillment Center's role?
• Which coverage level describes a plan where the insurer covers about 90% of a consumer's healthcare costs?
• What term refers to information that can distinguish or trace an individual's identity, alone or when linked or linkable to a specific individual?
• Which term describes unauthorized access to personally identifiable information?
• Which form reports to taxpayers the health coverage details if they received Medicaid coverage?
• Which term best describes a consumer assistance worker who works at the Consolidated Services Center and assists consumers with their applications over the phone?
• Which statement is true about the 5-year bar exemptions?
• Which term would you use to describe the monthly fee for maintaining health coverage, separate from service costs?
• Which of the following is NOT listed as a Maryland Medicaid Program?
• Which term describes a plan level where the insurer covers 70% of costs?
• A broad term that refers to a physical, mental, sensory, or cognitive impairment that substantially limits one or more major life activities.
• Which group is exempt from paying the MCHP monthly premium?
• Which statement about the Family Planning Program is true?
• Which coverage group is defined as adults under 65 with no dependent children and income <= 138% FPL?
• Which plan type is typically chosen by consumers who want a plan that requires referrals and coordinates care through a primary care physician?
• Which term describes a health insurance option typically offered to young consumers with a low monthly premium and very high deductible?
• What is the term for a health and/or dental insurance provider?
• HMO is an acronym for which type of health plan?
• Which Maryland Medicaid option provides home and community based services waivers to support community living?
• What is a key characteristic of the MCHP Premium program?
• Which coverage group includes deemed newborns, newborns whose mothers were receiving Medicaid at the time of birth?
• What are the two types of Medicaid eligibility requirements?
• What term describes fraudulent use of someone else's personal information, such as a Social Security Number or insurance policy identification card, for financial or personal gain?
• Which federal law may allow a consumer to temporarily keep health coverage after certain events, requiring payment of 100% of premiums plus a small administrative fee?
• Which term describes an electronic written note placed in an applicant's electronic case file?
• What is the easy-to-read summary that lets a consumer make apples-to-apples comparisons of costs and coverage between health plans?
• Which term refers to the annual period during which consumers may enroll or change coverage for the next year?
• Maryland Language Line offers interpretation in how many languages?
• Which of the following is a requirement for Non-Financial Eligibility for Maryland health coverage?
• Which document provides a summary of plan benefits, shows coverage examples, and allows apples-to-apples comparisons, and is not a contract?
• Which plan type covers services only when using in-network doctors, specialists, or hospitals, except in an emergency?
• Which category includes Insurance Fraud, Identity Theft and Conflict of Interest?
• What is the fixed amount a consumer pays for a doctor's visit or prescription at the time of service?
• The group of plan options including Bronze, Silver, Gold, Platinum, and Catastrophic is referred to as what?
• The 1095 A/B forms are included in which functional area?
• What are Unfair Trade Practices?
• Which term describes the consumer's share of the cost of covered services?
• Which term describes a health plan's ability to deliver promised benefits by providing reasonable access to in-network primary and specialty care and other services under the contract?
• Money or compensation an individual receives for their labor, services or work-related activities, wages, salaries, tips, commissions, and bonuses earned from employment, as well as income from self-employment or business activities.
• Tier 3 usually includes which type of medications?
• Who are authorized insurance brokers licensed by the Maryland Insurance Administration to assist consumers with plan selection in Maryland Health Connection?
• What term is used for equipment ordered for daily or extended use in health care?
• Which term describes a health plan offered on Maryland Health Connection that is certified by MHBE to meet ACA and Maryland Law?
• Financial eligibility for Maryland Health Connection is based on MAGI?
• Which term describes an individual who holds an individual exchange navigator certification and provides services for a Connector Entity?
• Tier 2 usually includes which type of medications?
• Which statement best defines Residency for Maryland health coverage purposes?
• Caretaker Relative is defined as which of the following?
• List of covered prescription drugs.
• Qualified Health Plans generally become effective on what date?
• Which colors are recommended for tops to reflect Maryland Health Connection branding?
• Form sent to taxpayers who receive minimum essential health insurance coverage under a Medicaid program.
• Which program is Maryland Children's Health Program (MCHP) / MCHP Premium?
• Which term refers to requirements for plan information accessibility, including a provider directory and a summary of benefits coverage (SBC) under health plan regulations?
• Which term describes a consumer assistance worker who works for MDH or DHS and specializes in Medicaid?
• Under the ACA, Medicaid coverage is extended to households with income up to what percent of the Federal Poverty Line?
• Which cost-sharing term refers to the fixed amount a patient pays for a specific service, such as a doctor visit or prescription?
• What measure of income is determined yearly by the Department of Health and Human Services and used to determine eligibility for programs and benefits?
• Which coverage group describes 19- to 20-year-olds with income greater than 123% but less than or equal to 138% of the FPL?
• HEAU stands for Health Education and Advocacy Unit. Where is this unit located?
• Which term describes the process that enables hospitals to submit eligibility for deemed newborns directly to MMIS through e-Medicaid?
• Which ACA requirement requires consumers who received advance premium tax credits to file Form 8962 to reconcile credits?
• Is personal space different across cultures?
• This year, what proportion of people who enrolled through Maryland Health Connection obtained coverage?
• The outreach dress guideline states CAWs should dress casual.
• In the material, Bronze Plan has what actuarial value?
• Gold Coverage Level is defined as which of the following?
• Which term describes authorized individuals licensed by the Maryland Insurance Administration who assist applicants with plan choices and have no fee?
• D02 Coverage Group eligibility applies to children under 19 with income in which range?
• What type of plan is characterized by paying less if you use doctors, hospitals, and providers that participate in the plan's network?
• Which role has access to the Broker Portal on the Maryland Health Connection exchange?
• Emergency Medical Services (EMS) is best described as which of the following?
• What describes the purpose of Plan Levels in terms of cost-sharing?
• UCR in health plan terminology stands for what?
• Which plan type generally limits coverage to care from doctors who work for or contract with the plan and may require you to live or work in the service area?
• The sum of attitudes, customs, and beliefs that constitute the shared bases of social action and distinguishes one group from another.
• Which coverage group covers children aged 19-20 with income <= 123% FPL?
• A child under 1 year old with income 205% FPL falls under which coverage group?
• Which term refers to organizations that service one region or more and are responsible for outreach in their region(s)?
• Which term describes the standards that carriers must meet for Maryland Health Connection plan years?
• Which statement correctly describes Former Foster Care Youth eligibility in Maryland?
• Since 2017, notices and taglines are available in the top how many languages spoken in Maryland?
• Which statement is true about the 5-year waiting period for federal benefits for certain applicants?
• What is the eligible age for Former Foster Care Youth Medicaid eligibility?
• The government does not allow people who can get affordable minimum essential coverage elsewhere to use affordability programs on the marketplace. Which scenario would make someone ineligible to use affordability programs?
• Which term describes the consumer's share of the cost of covered services paid out-of-pocket?
• Should you revisit options even if you've shopped before?
• Which term is used for the person who can assist with applications or renewals by acting on the consumer's behalf?
• Which term describes a subsidy providing reduced out-of-pocket costs for certain income ranges?
• Which program provides health insurance for eligible low-income individuals and families?
• Lawfully present pregnant women and children are not subject to which waiting period for federal benefits?
• A drug formulary usually includes which type of medications?
• What is the primary purpose of accumulators in health plans?
• Which Maryland Medicaid program helps pay Medicare costs for people with limited incomes?
• Which term describes the maximum amount a plan will pay for a specific service, regardless of service cost?
• Which coverage group covers disabled individuals whose household income is at or below 77% of the Federal Poverty Level and who do not have Medicare or dependent children under age 21?
• What is the fee-for-service Medicaid coverage for up to three months prior to initial application for eligible individuals with unpaid medical bills called?
• Which system collects Medicaid enrollment information and processes Medicaid claims?
• Under the ACA, Maryland's expansion made which group eligible?
• Which role primarily works with Medicaid enrollment and helps consumers access the consumer portal?
• Which enrollment period allows enrollment outside Open Enrollment due to life events such as marriage, divorce, or birth?
• What term refers to the amount a consumer pays for health insurance each month?
• For consumers under 150% FPL, silver CSR plans have what actuarial value?
• Which statement describes a US National?
• Which Maryland Medicaid program focuses on family planning services?
• Which statement best describes Maryland Health Connection?
• Which entities may qualify for a tax credit when offering health insurance to employees through Maryland Health Connection for Small Business?
• What term is used for the amount a consumer pays for their health insurance every month?
• Which term refers to a health and/or dental insurance company, sometimes called an issuer?
• Which term describes the access to care guaranteed by ensuring providers within a network can be used to receive covered services?
• What is the maximum amount a consumer will have to pay out of pocket in one plan year?
• What are easy-to-read outlines that let you compare costs and coverage between health plans?
• Which option best describes P02 coverage group?
• What term describes the maximum amount an individual must pay out of pocket in a calendar year?
• Which Maryland coverage group is not subject to an income limit?
• Which list correctly names the plan levels discussed in the material?
• What is the maximum amount a consumer must pay for covered services in a plan year before the plan pays 100%?
• Which agency is the state's primary social service provider serving over one million people annually?
• What is the annual period during which consumers may change fringe benefit options and enroll in QHPs/SADPs?
• If the MCHP premium is not paid, what is the consequence?
• Which group is employed by the Maryland Department of Health and the Department of Human Services and specializes in Medicaid enrollment?
• CACs should be able to answer most eligibility and QHP related questions but are not authorized to help individuals select an MCO.
• Which statement best defines unearned income?
• A concept and practice involving self reflection, open-mindedness, and a willingness to learn and understand the beliefs, values, and experiences of individuals from diverse cultural backgrounds.
• Which unit provides mediation for disputes between consumers and healthcare providers or HMOs?
• What term means the net earnings from a business that the consumer or household member owns, or from work as an independent contractor?
• Under the P07 Coverage Group, what is the income limit for children aged 6 to less than 19?
• Which area prevents, detects and corrects violations of state and federal laws and promotes a culture of compliance?
• Which group is explicitly mentioned as eligible for limited cost-share variations of Bronze, Silver, and Gold level plans?
• MAGI is used to determine eligibility for which programs?
• Which term describes the five-year waiting period before eligible for certain federal benefits, including Medicaid, with an exemption for lawfully present pregnant women and children?
• Which term refers to the state of being confined in prison?
• In health plan terms, which statement aligns with minimum value?
• Which statement correctly describes exclusions in a health plan?
• Is a Social Security Number always required for Non-Financial Eligibility?
• Which plan type covers services only if you use in-network providers (except emergencies)?
• Which Maryland department administers the state's Medicaid program?
• What is the financial credit aimed at lowering the cost of private health insurance for eligible individuals and families with low to moderate incomes (up to 400% of the Federal Poverty Level - FPL)?
• For homeless applicants, which statement about applying and address entry is correct?
• Certified application counselors (CACs) are trained to assist with eligibility and enrollment and should be able to answer most questions; however, they are not authorized to help an individual select an MCO.
• What term represents the proportion or percentage of the total costs for covered benefits that a health insurance plan will cover?
• Which term describes the geographic areas served by connector entities where trained navigators provide in-person assistance with health coverage enrollment?
• In the Plan Levels context, which term describes the portion of costs the insurance carrier is responsible for paying?
• Former Foster Care eligibility extends until what age?
• The Summary of Benefits and Coverage (SBC) is best described as a document that:
• Pregnant women whose income is greater than 189% and less than or equal to 264% of the federal poverty level (FPL) fall into which Maryland coverage group?
• Which describes a PPO (Preferred Provider Organization) plan?
• An incident is defined as which of the following?
• Which term describes the maximum amount a consumer pays for health insurance out-of-pocket in a single plan year?
• Which statement about pregnancy-related coverage is true?
• What term describes the list of medications approved for coverage by a health plan?
• What term describes a subsidy for consumers with incomes 100% to 250% FPL to lower out-of-pocket costs such as deductibles, co-pays, or annual out-of-pocket maximums?
• What term describes a system that tracks the total amount of money a policyholder pays toward out-of-pocket expenses during a calendar year?
• Which term refers to the decision that assesses eligibility for health insurance options through the Maryland Health Benefit Exchange?
• Which group is listed as having no five-year bar requirement?
• The EMS application is located in which portal for workers who have the X03 role only?
• What happens to the Advance Premium Tax Credit when it is applied in advance?
• What term refers to a designated representative who acts on a consumer's behalf with MHBE?
• Which term is the abbreviation for information that can identify a person?
• Which of the following is true about affordability in employer-sponsored plans?
• Which of the following best defines Habilitative Services?
• HBX is described as a set of ancillary systems facilitating Eligibility & Enrollments. Which option best matches this description?
• Which term is the amount paid each plan year before insurance begins to pay for services (with some exceptions)?
• Which plan type restricts services to in-network providers except in emergencies?
• How can a consumer receive the tax credit amount to lower monthly premiums?
• Which document is used to compare plan options based on price and benefits and is specifically titled to reflect coverage?
• Which feature is associated with Qualified Health Plans (QHPs) in relation to provider networks?
• Which term describes a team of navigators located in every county in Maryland helping consumers determine if they qualify for lower-cost health plans or for free health coverage through Medicaid?
• Which income range defines D04 Coverage Group eligibility?
• Which programs are included when MAGI is used to determine eligibility in Maryland Health Connection?
• Which term is the amount a plan will pay for a service, up to a maximum?
• Which term describes paying a percentage of the cost of a medical service, with the remainder paid by the carrier?
• What term refers to a husband's or wife's court-ordered provision for support after separation or divorce?
• If information cannot be verified electronically for a QHP, what will the consumer receive and how long do they have to verify?
• Which term describes a community-based entity that coordinates health coverage information and helps connect people to resources?
• What does EDI stand for in the context of exchanging enrollment information?
• A person who resides in Maryland with the intent of remaining permanently or for an indefinite period is described as a:
• For homeless applicants, what address action should be taken in the Maryland Health Connection?
• What determines the amount of the Premium Tax Credit a person can receive?
• Which unit handles mailing outbound notices, 1095 forms, paper applications, and voter registration forms, and also uploads inbound documentation into HBX?
• Which term describes the portion of costs borne by the consumer as part of cost sharing?
• Which role assists consumers in determining eligibility for financial assistance programs and Medicaid, and helps enroll in qualified health and dental plans, operating under Connector Entities?
• What is Maryland Health Connection?
• Who receives payments once enrolled?
• Which term refers to doctors, other health care providers, and hospitals contracted with a plan to provide medical care to its members?
• Which Maryland Medicaid program covers aged, blind or disabled individuals?
• According to the material, Catastrophic plans are available to which group?
• HBX is the acronym for Health Benefit Exchange and is often used interchangeably with which Maryland program?
• P14 Coverage Group eligibility includes which of the following?
• Which term describes a consumer assistance worker who specializes in Medicaid at MDH or DHS?
• What is the monthly payment you make to maintain health insurance coverage called?
• Which coverage group covers children aged 19-20 with income <= 123% FPL?
• Which law addresses liability for defrauding federal programs such as Medicaid?
• What is the highest amount a consumer will pay out-of-pocket in one plan year?
• Which term describes an integrated care approach to managing illness that includes screenings, checkups, monitoring and coordinating treatment and patient education?
• What is the purpose of subsidies under the ACA?
• What term describes a group of people who are eligible for assistance based on status or need and requiring special attention due to unique needs?
• F05 Coverage Group is for which population?
• Which term describes the live transfer of a consumer to a participating producer when shopping for Qualified Health Plans?
• Which of the following is a Maryland voter registration criterion?
• What is Verification?
• Occurs when a Consumer Assistance Worker fulfills that duty while attempting to achieve personal gain at the same time.
• Which statement describes US Citizenship in this context?
• Which groups are included under Special Population Groups?
• Which of the following is an example of Habilitative Services?
• Which program provides health coverage for eligible low-income Maryland residents?
• Maryland Medicaid Programs cover which of the following groups?
• Which term describes a health insurance plan offered on Maryland Health Connection and certified by MHBE to meet ACA and Maryland Law?
• What term refers to the annual period when individuals can enroll or change plans with Maryland Health Connection (November 1 to December 31)?
• Plan Levels are described as differing based on what main factor?
• A consumer assistance worker who is employed by an application counselor sponsoring entity is known as what?
• Which statement about perinatal coverage and eligibility is true?
• Which term means a duty that is compromised by personal gain?
• Under the P07 Coverage Group, what is the income limit for children aged 1 to less than 6?
• Which factor determines eligibility for the Premium Tax Credit?
• What is the agreement in which a small employer that does not offer health insurance can help pay for medical expenses for its employees?
• What is the formal request to review or reconsider a health plan decision about eligibility or enrollment?
• What term describes the products and services covered under health plans?
• What term refers to a dental plan that complies with ACA requirements and includes pediatric dental benefits?
• Which role includes assisting with eligibility determinations, may connect consumers to food stamps and cash assistance, and help them access Medicaid, including assistance with MCO enrollment?
• For consumers between 201% and 250% FPL, silver CSR plans have what actuarial value?
• Which term denotes a consumer assistance role that helps people apply for coverage?
• Which agency is responsible for establishing and maintaining the state-based marketplace for insurance affordability programs, Maryland Health Connection?
• What is the method used to verify a consumer's identity online or by phone using Experian as the reference?
• Which term describes an agreement that allows a small employer to help pay for employees' medical expenses when the employer does not offer health insurance?
• Which agency provides regulation and enforcement for the state's insurance industry?
• Federal and State voter registration laws require certain organizations to assist clients with voter registration. Which Maryland organization is identified as one of those organizations?
• Which coverage group includes children ages 19-20 with income greater than 123% and up to 138% of the Federal Poverty Level?
• Which date fields determine the end of the 12-month postpartum period?
• Which term describes a health insurance plan largely offered to consumers under 30 with a low monthly premium and very high deductible?
• What term describes a medical bill from a provider billing a patient for the difference between the total charge and the insurer's payment?
• D04 Coverage Group eligibility applies to which income range?
• MCHP targets uninsured children under 19 with income greater than which percentage of FPL?
• Which are DOs for effective communication with consumers from different cultures?
• What term means the total income for a family in a calendar year?
• Which term is the federal law that enables temporary continuation of health coverage after leaving employment?
• In the Broker Assistance Transfer Program, what term is used for the live transfer mechanism to a participating producer?
• Which term best describes the shared beliefs and practices of a group that influence health care interactions?
• The decision made about insurance affordability program eligibility after application is submitted.
• What is Workers Compensation?
• Which title best describes roles within consumer assistance such as Navigator, Caseworker, Call Center Representative, and Application Counselor?
• For a child aged 3 in P13 Coverage Group, which income range would apply?
• Which plan has a 90% actuarial value?
• Which statement best describes the role of navigators?
• Which Maryland Medicaid program serves employed individuals with disabilities?
• What is the term for a listing of healthcare providers participating in the carrier's network?
• Which term describes an insurance plan level under which the carrier covers 60% of healthcare costs?
• Which statement about Plan Levels is true?
• Family Planning Presumptive Eligibility is determined through which system?
• What insurance plan level covers 70% of the healthcare costs incurred under the plan?
• Which organization coordinates medical care for Medicaid enrollees under a contract with the Maryland Department of Health?
• What is a Binder Payment?
• Which term is used to describe the state's online eligibility and enrollment site for ACA programs?
• Which document is used to compare benefits and out-of-pocket costs across plans?
• Catastrophic Plans are described as including which of the following?
• Which area includes MHBE IT (website errors) and 1095 A/B?
• Form which provides information about a household's insurance policy, premium, any advance payment of premium tax credit, and the individuals covered.
• Which plan type generally requires using in-network providers to obtain lower costs and may require PCP referral for specialists?
• Which special population group may be eligible for Medicare and Medicaid at the same time under certain circumstances?
• Which Maryland Medicaid program focuses on long-term supports and services?
• What is a key purpose of the Summary of Benefits and Coverage (SBC)?
• What is the key element of residency determination?
• Which term refers to the products and services covered under health plans?
• Money that a consumer does not regularly receive, such as a lottery award, an inheritance, a lawsuit award or settlement, or an award for back unemployment compensation.
• Tier 4 usually includes which kind of drugs?
• What tool can you use in the Maryland Health Connection application to ensure your preferred health care professionals are included?
• Which term describes authorized insurance brokers who help applicants choose an insurance company and health plan and there is no fee?
• What term represents the standards that carriers must meet for Maryland Health Connection plans?
• Who is described as the individual applying for coverage or already enrolled in coverage?
• What is the period outside the yearly Open Enrollment Period when an applicant may enroll in or change their plan due to a qualifying life event?
• Which plan is described as a network-based plan with potential costs for out-of-network services and is commonly contrasted with HMO plans?
• Approximately what percentage of Marylanders age 5 and over speak a language other than English at home?
• Which description best matches a Verification Checklist Item (VCL)?
• Which statement defines affordability in employer-sponsored plans?
• Which statement best describes affordability for employer-sponsored coverage?
• Medicaid was enacted under Title XIX of the Social Security Act.
• To access cost-sharing reductions, the consumer must enroll in which plan?
• Which term refers to the easy-to-read summary that helps consumers compare costs and coverage across plans?
• What does MMIS stand for in Maryland's Medicaid system?
• Which role is licensed to advise on enrolling in the best Qualified Health Plans to suit needs but does not assist with Medicaid enrollments?
• What is the ACA threshold for classifying 'large employers' in terms of employee count or equivalent?
• Which term refers to babies whose mothers were enrolled in Medicaid at birth and who qualify for P06 coverage for 13 months, with household income not counted?
• Silver CSR plans are available to consumers with incomes below what percentage of the federal poverty level?
• What term describes money earned from working a standard job as an employee?
• The ACA provision requiring large employers to offer affordable, minimum value health insurance or face penalties is called?
• Which item is not considered an out-of-pocket expense for calculating cost sharing: deductible, copay, coinsurance, premium?
• US National status is typically described as which of the following?
• Which resource offers centralized phone assistance for applications and enrollment for the Maryland Health Connection?
• Which federal agency is described as being responsible for Medicaid, Medicare, and implementation of the Affordable Care Act?
• Which term refers to a person who applies for coverage or is already enrolled in coverage?
• Which coverage group includes adults under 65 with no dependent children and income <= 138% FPL, or disabled individuals whose income is between 77% and 138% FPL who are in the two-year Medicare waiting period following disability determination?
• Which term refers to the procedure to amicably resolve an applicant's appeal request by reviewing the applicant's individual exchange eligibility determination with an MHBE representative before a formal hearing?
• Which term describes individuals who comprise a family unit and who either live together under the same roof or are claimed together on the same tax return?
• When interacting with consumers, how should eye contact be managed?
• Under the Fee-for-Service model, this is contrasted with which managed care approach?
• What process involves carrier submission of plans for review and certification before plans are published on the Maryland Health Connection?
• To activate health insurance coverage by paying the binder, or initial monthly premium, payment.
• How many primary care visits are covered before the consumer must begin paying toward the deductible in these CSR plans?
• Which option is not one of the standard plan levels listed in the material?
• For consumers between 151% and 200% FPL, silver CSR plans have what actuarial value?
• Which team coordinates with business/technical teams for triage and simple case resolution?
• What is Employer-sponsored insurance?
• A program that provides medical coverage for qualifying uninsured children under the age of 19.
• A legally recognized subject or national of a state, in our case, the United States of America, is called what?
• Which term describes a job-based health plan that covers only the employee and costs 9.12% or less of the employee's household income?
• Outreach events may include which of the following?
• What is the 1184 Process?
• Which document is not a contract or policy but provides a uniform glossary and helps consumers compare plans?
• Which term refers to the products and services covered under health plans?
• What components comprise MAGI calculation?
• What is the ACA minimum for all qualified health plans called?
• What process allows a consumer to be verified online or by phone by providing verification information that Experian recognizes?
• Which cost-sharing arrangement involves paying a percentage of costs after the deductible has been met?
• Which term denotes the total annual income used to assess eligibility for health coverage?
• What is the comprehensive health care reform law that requires states to offer mechanisms for health coverage to uninsured and provides numerous rights and protections to all consumers?
• What is the amount you must pay out-of-pocket before your insurance begins to pay for services in a plan year?
• Preferred Specialty Drugs are best described as which?
• Deemed Newborns are eligible for coverage for how long after birth?